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To improve elderly patients' understanding and safe usage of their medications. English-speaking hospital inpatients aged > or =65 years were recruited. They were self-medicating at home with at least 1 regular medication and had a Mini-Mental State Examination (MMSE) score of at least 20 out of 30. The patients were taught medication details on 3 consecutive days. The patients' medication knowledge was recorded before education and again at a home visit after discharge from hospital. Patient medication knowledge before education showed that participants knew 50% of brand names, dosage and times, 55% of medication purpose, and 15% of major side effects. At follow-up home visits, the relevant figures improved significantly to 90%, 85%, and 25%, respectively (P < or = .05). Similar improvement occurred in the 2 patient groups with an MMSE score of 20 to 24 and 25 to 30 (P = .03). This simple, practical, nursing-staff-conducted program worked well in a hospital setting and resulted in improved medication knowledge, even in patients with mild cognitive impairment.

Aim: To describe the characteristics, outcomes and treatment complications of patients with pulmonary embolism (PE) who were treated at home and as outpatients in an ambulatory care program. Methods: Retrospective descriptive study of patients with PE who were treated in the ambulatory care unit during 2003. Ambulatory care unit data and medical record information were reviewed. Data collected included demographic and clinical data, standard clinical indicators of unplanned admission during treatment program, incidence of major bleeding, recurrent venous thromboembolism (VTE), and death within 3 months of admission into the ambulatory care program. Results: 130 patients with PE were treated: 46% were treated totally as outpatients and 54% as early discharge patients. Mean age was 66.4 years; 61% were women. The program was successfully completed for 89% of patients; one patient was lost to follow-up. There were three episodes of major bleeding (2%; 95% Cl, 0.5%-7%), all in patients aged > 70 years. Four patients died (3%; 95% Cl, 0.8%-8%) within 3 months of admission into the program, but none in the first week, no death being directly attributable to PE. There were seven episodes of recurrent VTE (5%; 95% Cl, 2%-11%). Conclusion: Appropriately selected patients with sub-massive PE can be treated as outpatients and in the home. Although the outcome is good in most patients, a significant proportion will require admission, emphasising the need for a well defined protocol and close medical supervision. Further study will more closely define at-risk patients and refine the care pathways.

To determine the prevalence of iron depletion and deficiency, and iron-deficiency anaemia, along with risk factors for iron depletion, in Australian-born children aged 12-36 months of Arabic-speaking background.Community-based survey.Central Sydney Area Health Service (CSAHS), NSW, April to August, 1997.All children born at five Sydney hospitals between 1 May 1994 and 30 April 1996, whose mothers gave an Arabic-speaking country of birth and resided in the area served by the CSAHS.Full blood count (haemoglobin, mean corpuscular haemoglobin, mean corpuscular volume), plasma ferritin concentration, haemoglobin electrophoresis, potential risk factors for iron depletion.Families of 641 of the 1,161 eligible children were able to be contacted, and 403 agreed to testing (response rate, 62.9% among those contacted). Overall, 6% of children had iron-deficiency anaemia, another 9% were iron deficient without anaemia, and 23% were iron depleted. Multiple logistic regression analysis showed three significant independent risk factors for iron depletion:37 weeks' gestation (odds ratio [OR], 5.88, P=0.001); mother resident in Australia for less than the median time of 8.5 years (OR, 1.96, P=0.016); and daily intake of600 mL cows' milk (OR, 3.89, P=0.001).Impaired iron status is common among children of Arabic background, and targeted screening is recommended for this group.

The plasma concentrations of vitamin A, vitamin E, beta-carotene and serum concentrations of zinc, retinol-binding protein and prealbumin were examined for a random cluster sample, stratified by socioeconomic status, of 467 healthy preschool children. Children were aged 9-62 months; 44% were females. The mean plasma values were: vitamin A, 1.29 micromol l(-1); vitamin E, 18.9 micromol l(-1); and beta-carotene, 0.30 micromol l(-1). The mean serum values were: zinc, 13.9 micromol l(-1); retinol-binding protein, 25.5 mg l(-1); and prealbumin, 186.2 mg l(-1). The mean molar ratio of vitamin A to retinol-binding protein for the study group was 1.10. There were no differences in the mean values of any of the measured micronutrients between the genders. The results of this survey do not indicate that the prevalence of micronutrient deficiency in this preschool population is of public health significance.

OBJECTIVES To determine the prevalence of elevated blood lead concentrations in preschool children in central and southern Sydney. PARTICIPANTS AND SETTING Children aged from 9 months to 5 years living in 32 randomly selected geographical areas in Central and southern Sydney. METHODS Venous blood lead concentrations were estimated by atomic absorption spectrometry. RESULTS 953 children were identified and 726 had parental consent to participate. A blood sample for lead estimation was obtained from 718 children. The geometric mean blood level concentration was 0.34 mu mol/L (7.0 mu/dL). The proportion of children with elevated blood lead concentrations was: 16.1% (>0.48 mu mol/L [10mu/dL]), 3.9% (>0.72 mu mol/L[15mu/dL]) and 0.3% (>1.21mu mol/L [25 mu/dL], respectively. The blood lead levels for children living with a 10-km radius of the Sydney Central Business district were: 25% (>0.48 mu mol/L [10mu/dL]) and 7% (>0.72 mu mol/L [15mu/dL]), respectively. Corresponding findings for children living 10 km outside this radius were: 9% (>0.48 mu mol/L [10mu/dL]) and 1.5% (0.72 mu mol/L [15mu/dL]), respectively. CONCLUSIONS The proportion of children with elevated blood lead concentrations in Central and Southern Sydney as a whole does not exceed current National Health and Medical Research Council (NHMRC) recommendations. However, in those areas within a 10-km radius of the Central Business District, NHMRC interventional guidelines for communities where more that 5% of children have blood lead concentrations higher than 0.72 mu mol/L (15 mu/dL) should be applied.

We assessed the hypothesis that having a non-English-speaking background (NESB), being very elderly, living alone, and having cognitive impairment were contributing factors to anticoagulant under-utilisation for atrial fibrillation in our local community. A questionnaire was mailed to 532 general practitioners (GPs) in three areas of metropolitan Sydney, Australia. The questionnaire included five case scenarios, regarding either an English-speaking background (ESB) patient, or an NESB patient, each characterised by potential barrier(s) for anticoagulant usage: being (1) elderly; (2) elderly with mild dementia; (3) elderly with mild dementia and living alone; (4) elderly with severe dementia; and (5) very elderly. The overall response rate was 34%. The percentage of GPs recommending anticoagulation was 57%, 50%, 6%, 25% and 23%, respectively, for the ESB scenario, and 48%, 32%, 4%, 14% and 18%, respectively, for the NESB scenario. Eighty-eight percent of GPs rated 'adherence to International Normalized Ration monitoring' as 'very important' in their decision. In conclusion, the factors proposed in our hypothesis were associated with a lower likelihood for anticoagulant prescription for atrial fibrillation.

Objectives – To examine 12-month outcomes and develop predictive models for outcomes in elderly stroke patients. Methods – Prospective study of 186 consecutive acute stroke patients aged ≥65 years admitted to a local hospital between March 2002 and March 2003. Outcome measurements included mortality, functional independence measure (FIM) score and nursing home placement. Two predictive models, using multiple logistic regression analysis, were developed to identify the factors associated with (i) mortality, and (ii) being alive and independent (defined as mean FIM score ≥90) at 12 months. Results – One hundred and seventy two (92%) patients were followed up at 12 months post-stroke. Mortality rate was 31%, and was significantly higher in nursing home vs non-nursing home origin patients (68% [15/22] vs 25% [38/150]). Nursing home placement for non-nursing home origin survivors was 28% (31/112). Age ≥85 years was associated with higher mortality (odds ratio = 5.3, 95% confidence interval = 1.8–15, P

Parkinson’s disease (PD) is the second mostcommon neurodegenerative disorder. Its preval-ence rises sharply after the sixth decade. Parkin-sonism is also common in the elderly. The study byBennet et al., found 15% of people aged 65–74,30% of those aged 75–84 and 50% of those aged 85and over had one or more parkinsonian signs (1).With an ageing population in developed countries,PD and parkinsonism will become more prevalentand important.An Australian epidemiological study publishedin 1966 (2) reported that the PD prevalence inAustralia was 66 per 100,000, which was muchlower than other developed countries (with theexception of Japan). The prevalence of PD in theUnited States of America, Europe and SouthAmerica has been consistently reported between150 and 300 per 100,000 (3). Since the survey in1966, the Australian population has aged signifi-cantly and the life expectancy at birth (both sexescombined) is now 79.2 years compared with70.9 years in 1965 (4).A pilot study in Randwick municipality ofSydney, Australia, from 1998 to 1999 revealedthat PD prevalence is substantially higher nowthan that reported in 1966 (5). The estimatedprevalence of PD (including newly diagnosedcases) in the Randwick community was 775 per100,000. If newly diagnosed cases were excluded,the prevalence would still have been as high as449 per 100,000. In contrast to the 1966 study(2), which used a general practitioner (GP)questionnaire, the Randwick survey used a two-step method with a screening phase followed byan examination phase. This difference in studymethodology may provide an explanation for thelower prevalence found in 1966 in that mildercases may not have presented to GPs in theearlier study, thus underestimating the true pre-valence of PD.The sample in Randwick was randomly chosenand although 2820 households were door-knocked,the eligible number (aged ‡55 years) involved inthe pilot study was small (n ¼ 527). Hence it wasdecided to repeat the study in another localgovernment area (LGA) of Sydney using thesame methodology. The new study was performedin Bankstown LGA.

To examine major bleeding and mortality rates of low molecular weight heparin (LMWH) and unfractionated heparin (UFH) for patients with pulmonary embolism (PE) and/or deep vein thrombosis (DVT), a retrospective review of the medical records for 286 patients who presented at a local hospital with PE and/or DVT during the period November 2002-August 2003 was performed.presence of co-morbidities, concurrent medications, presence, site and severity of bleeding, outcome. Of all the patients, 50.7% received LMWH plus warfarin, 21.0% received UFH plus LMWH plus warfarin, 14.0% received UFH and warfarin, and 9.8% received LMWH only. There were nine minor bleeds and six major bleeds, which resulted in four deaths. Being a hospitalized patient and being ageor =70 years were associated with a major bleed (p0.05). For hospital inpatients ageor =70 years on UFH and LMWH the number of major bleeds/1000 patient days was 18.9 and 9.2, respectively. The major bleeding rate is comparable if not better than that reported in the literature in our hospital setting where nearly half of the anticoagulation services were provided as ambulatory care. The increased rate of bleeding in the elderly we found is consistent with the findings of previous studies.